**2.3 Cardiovascular risk assessment**

A rational and successful approach to reducing the CVR involves stratifying risk and the periodic evaluation of the outcomes. Accurate CVD risk estimation in people with T2DM without established CVD can identify patients at high risk of developing CVD and can thus be used to adapt the intensity and complexity of appropriate treatment. For practice, CVR assessment scores which can be applied in diabetes are beneficial. Several CVR calculation scores in DM have been developed. The first is the result of the United Kingdom Prospective Diabetes Study (UKPDS), in which, in people newly diagnosed with T2DM, the effect of intensive treatment on the evolution of chronic complications compared to conventional treatment was followed. UKPDS Risk Engine estimates the risk of fatal and non-fatal coronary events and fatal and non-fatal stroke at 15 and 30 years, in people with T2DM without CV disease, considering the duration of DM, age, gender, ethnicity, smoking, presence of atrial fibrillation, the level of HbA1c, systolic blood pressure, total cholesterol and HDL-C (https://www.dtu.ox.ac.uk/riskengine/) [17].

Another score (Advance Risk Engine) is based on ADVANCE and ADVANCE-ON studies. It refers to patients with T2DM without CVD, is based on the usual parameters and estimates the risk of major CV events at four years, the risk of renal events at five years and the risk of major vascular disease at ten years (www.advanceriskengine.com) [18].

The American Heart Association (AHA) and American College of Cardiology (ACC), developed a risk score to estimate the ten-year risk for the first ASCVD event (non-fatal myocardial infarction or CHD death, or fatal/non-fatal stroke) (available online at tools.acc.org/ASCVD-Risk-Estimator-Plus) [19].

Based on the ACCORD trial population, the BRAVO risk engine has been recently developed. It contains three separate modules addressed to events (stroke, MI, HF, angina, revascularization surgery, renal events, blindness, hypoglycemia), risk factors and mortality [20].

None of these CVR estimation scores is perfect, so clinical judgment and consideration of CVR factors are important for setting and selecting appropriate therapeutic goals and interventions.
